Understanding ACL Surgery and Rehabilitation in 2023

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Anterior Cruciate Ligament (ACL) injuries frequently affect athletes and those leading active lifestyles. When the ACL sustains significant damage or tears, it necessitates surgical treatment, marking a pivotal phase in the path to recovery and the resumption of an active way of life. This article delves into the critical components of ACL surgery, encompassing its procedures, the subsequent rehabilitation course, and post-surgery expectations.

The Anatomy of the ACL

The ACL represents one of the four principal ligaments crucial for knee joint stability. Its primary function is to deter excessive forward movement and rotational motion of the shin bone (tibia) concerning the thigh bone (femur). ACL injuries often transpire during high-impact activities, particularly in sports, where abrupt twists, pivots, or direct knee impacts can result in tears or ruptures.

Understanding ACL Surgery

ACL surgery is typically recommended when non-surgical treatments and physical therapy fail to provide the desired level of stability and function. The surgery aims to repair or reconstruct the torn ACL, ultimately restoring the knee’s stability and reducing the risk of future injury.

There are two primary approaches to ACL surgery:

ACL Repair: In some cases, if the ACL tear is partial and located in a specific region of the ligament, it may be possible to repair it. This involves stitching the torn ends together to promote healing. However, this method is less common than reconstruction and is only suitable for select cases.

ACL Reconstruction: The more common approach is ACL reconstruction, which involves replacing the damaged ACL with a graft. This graft can be obtained from various sources, such as the patient’s patellar tendon, hamstring tendon, or allograft (cadaver tissue). The graft is attached to the bones with screws or other fixation devices.

The Surgical Procedure

ACL surgery is typically performed arthroscopically, which is minimally invasive. During the procedure, small incisions are made around the knee joint, and a tiny camera (arthroscope) is used to guide the surgeon. This approach reduces scarring and allows for a faster recovery.

Rehabilitation and Recovery

Recovery from ACL surgery is a multi-phased process that requires patience, dedication, and professional guidance. The rehabilitation process can be broadly divided into the following phases:

  1. Immediate Postoperative Care: The initial period following ACL surgery focuses on pain and swelling management. Patients are frequently advised to utilize crutches and don a knee brace. In many cases, physical therapy commences shortly after the surgery to enhance range of motion and fortify the adjacent muscles.
  2. Regaining Range of Motion: Over the next few weeks, the focus shifts to regaining full range of motion in the knee joint. Physical therapy exercises are essential to prevent stiffness and improve flexibility.
  3. Strengthening Exercises: As the knee becomes more stable, strengthening exercises become a primary focus. Building strength in the quadriceps, hamstrings, and calf muscles is crucial to support the knee and prevent future injuries.
  4. Functional Training: For athletes and individuals leading active lifestyles, this phase entails specialized sport-specific training designed to reacquire precise movements, enhance agility, and improve coordination. The ultimate goal is to reestablish their capability to engage in sports or other physically demanding pursuits.
  5. Return to Play: The final phase of rehabilitation involves a gradual return to sports or other high-impact activities. The timing of this phase varies from person to person and should be guided by a healthcare professional. It’s essential to ensure the knee is fully prepared for the demands of your chosen activities.


ACL surgery is a critical step in the journey to recovery for individuals with ACL injuries. While the procedure itself is minimally invasive, the post-surgery rehabilitation process requires commitment and patience. By following the guidance of healthcare professionals and diligently engaging in physical therapy, patients can regain their knee’s strength and function, ultimately allowing them to return to the activities they love. Remember, the road to recovery may be challenging, but it is a well-traveled path with a high success rate, and many individuals regain full mobility and athleticism after ACL surgery.

ACL Surgery FAQ

Collaborate with your physical therapist to strike the right activity-rest balance post-ACL surgery. Recovery usually spans 2-9 months, with athletes often resuming their sport after at least six months.
Small tears (sprains) can mend with non-surgical and regenerative therapies. However, complete ACL tears require surgery for recovery. If your activities don't involve knee pivots, physical therapy might suffice.
Rest: 0-2 Weeks Post-ACL Surgery
In the initial weeks following surgery, prioritise rest and incision care. Elevate your leg (at calf or ankle) on pillows 4-6 times daily to minimise swelling.
Patients start unassisted walking at 2-4 weeks for brief periods. By 10-12 weeks, brisk walking, light jogging, and plyometric exercises are possible. Full ACL reconstruction recovery takes 6-12 months or more with physical therapy.


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